Aortic Valve Replacement in Dextrocardia and Anomalous Origin of the Coronary Artery

Area of Science:

• Cardiology
• Cardiac Surgery
• Medical Genetics

Background:

• Situs inversus totalis (SIT) is a rare congenital condition where major visceral organs are mirrored.
• Anomalous origin of the left coronary artery (ALCA) is another rare congenital anomaly.
• The simultaneous occurrence of SIT and ALCA presents unique surgical challenges, particularly in elderly patients.

Observation:

• An 87-year-old female patient presented with symptomatic aortic stenosis.
• The patient was diagnosed with both situs inversus totalis and anomalous origin of the left coronary artery.
• This combination of rare conditions in a very elderly patient is unprecedented in existing literature.

Findings:

• The patient successfully underwent aortic valve replacement (AVR) and coronary artery bypass grafting (CABG).
• A saphenous vein graft was used for bypass to the left main trunk.
• The surgical procedure was performed without significant difficulty, with the operator positioned on the patient's left side.

Implications:

• This case demonstrates the feasibility of complex cardiac surgery in patients with rare congenital anomalies.
• It suggests that careful pre-operative planning and surgical adaptation can overcome anatomical challenges.
• The successful outcome in this elderly patient broadens the potential surgical options for individuals with combined SIT and ALCA.